Description:Position SummaryThe Referral Nurse serves as a key clinical resource within the STAR Kids Medicaid managed care program, providing comprehensive in-person assessments for children and youth (ages 0–20) with disabilities or complex medical needs. This role applies a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services that align with the member’s benefit plan and health needs, promoting optimal, cost-effective outcomes through effective communication and resource utilization.Key ResponsibilitiesConduct comprehensive in-person assessments using clinical tools and data review to determine member needs, eligibility, and appropriate interventions.Develop and implement Individual Service Plans (ISP) in collaboration with members, families, and interdisciplinary teams.Coordinate Medicaid benefits, long-term services and supports (LTSS), and community resources to meet member needs.Apply and interpret clinical criteria, guidelines, and regulatory standards to ensure accurate administration of benefits.Facilitate transitions of care and ensure continuity of services across settings.Document all assessments, care plans, and communications in compliance with HHSC STAR Kids contract requirements and company policies.Collaborate with service coordinators, providers, and external agencies to resolve barriers to care.RequirementsActive, unrestricted RN license in Texas.Minimum 2 years of clinical experience in pediatrics, case management, or home health REQUIRED.Strong knowledge of Medicaid benefits, STAR Kids program requirements, and regulatory standards.Excellent communication, organizational, and problem-solving skills.Ability to work independently in the field and manage multiple priorities.Experience with Medically Dependent Children Program (MDCP) or other waiver programs.EducationActive RN license in TX that has no history and is unrestricted.Notes:Monday-Friday 8-5 hours may vary at times due to member availability. Training will be Monday-FridayThis is a FIELD and Telephonic role; 85% travel. Candidates will be required to have a dedicated home office free of distractions and complies with HIPPAA requirements.VIVA is an equal opportunity employer. All qualified applicants have an equal opportunity for placement, and all employees have an equal opportunity to develop on the job. This means that VIVA will not discriminate against any employee or qualified applicant on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status
Description:Position SummaryThe Referral Nurse serves as a key clinical resource within the STAR Kids Medicaid managed care program, providing comprehensive in-person assessments for children and youth (ages 0–20) with disabilities or complex medical needs. This role applies a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services that align with the member’s benefit plan and health needs, promoting optimal, cost-effective outcomes through effective communication and resource utilization.Key ResponsibilitiesConduct comprehensive in-person assessments using clinical tools and data review to determine member needs, eligibility, and appropriate interventions.Develop and implement Individual Service Plans (ISP) in collaboration with members, families, and interdisciplinary teams.Coordinate Medicaid benefits, long-term services and supports (LTSS), and community resources to meet member needs.Apply and interpret clinical criteria, guidelines, and regulatory standards to ensure accurate administration of benefits.Facilitate transitions of care and ensure continuity of services across settings.Document all assessments, care plans, and communications in compliance with HHSC STAR Kids contract requirements and company policies.Collaborate with service coordinators, providers, and external agencies to resolve barriers to care.RequirementsActive, unrestricted RN license in Texas.Minimum 2 years of clinical experience in pediatrics, case management, or home health REQUIRED.Strong knowledge of Medicaid benefits, STAR Kids program requirements, and regulatory standards.Excellent communication, organizational, and problem-solving skills.Ability to work independently in the field and manage multiple priorities.Experience with Medically Dependent Children Program (MDCP) or other waiver programs.EducationActive RN license in TX that has no history and is unrestricted.Notes:Monday-Friday 8-5 hours may vary at times due to member availability. Training will be Monday-FridayThis is a FIELD and Telephonic role; 85% travel. Candidates will be required to have a dedicated home office free of distractions and complies with HIPPAA requirements.
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